Provider Demographics
NPI:1134175326
Name:COONS, MICHAEL JOHN (OD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JOHN
Last Name:COONS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2758
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50704-2758
Mailing Address - Country:US
Mailing Address - Phone:319-234-2616
Mailing Address - Fax:319-234-1939
Practice Address - Street 1:909 E SAN MARNAN DRIVE
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50702-5611
Practice Address - Country:US
Practice Address - Phone:319-234-2616
Practice Address - Fax:319-234-1939
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01769152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA48265OtherWELLMARK INS PLAN
IA1199398Medicaid
IA421417307C7OtherJOHN DEERE HEALTH INS PLA
IA48265OtherWELLMARK INS PLAN
T01143Medicare UPIN